Tripterygium glycosides for treatment of nephrotic syndrome: A systematic review and meta-analysis of randomised controlled trials

Introduction Tripterygium glucoside (TG) is a Chinese herbal extract ingredient, and has been widely used for the treatment of nephrotic syndrome (NS) in China. This study aimed to evaluate the efficacy and safety of TG for treatment of NS present in people with various clinical conditions. Methods Six electronic databases were searched. The Cochrane risk of bias tool was used to evaluate the methodological quality of included trials and meta-analyses were conducted using RevMan and R software. Results 50 RCTs involving 3401 participants were finally included. The methodological quality of the included trials was not high. Meta-analyses showed no statistically significant difference between TG alone and conventional medication in most of the outcomes except for blood urea nitrogen. TG in combination with conventional medication was superior to conventional medication alone for urinary protein (−0.75 g/24 h, 95%CI: −1.02 to −0.49), serum albumin (2.87 g/L, 95%CI: 0.91 to 4.84), serum creatinine (−6.98 μmol/L, 95%CI: −11.54 to −2.41), complete remission (RR: 1.30, 95%CI: 1.18 to 1.42), relapse (RR: 0.41, 95%CI: 0.28 to 0.61) and adverse events (RR: 0.59, 95%CI: 0.46 to 0.76). Adverse events included nausea, vomiting, leukopenia, impaired liver function etc. Conclusions TG may have many beneficial effects according to various laboratory endpoints but there was no strong evidence to demonstrate its independent positive effect on improving renal function for NS. The included trials had high heterogeneity with low methodological quality. Future RCTs with clearly defined intervention type and clinically meaningful treatment duration are warranted to confirm the efficacy of TG.